Provider Demographics
NPI:1477377992
Name:MASSENGILL, JOLYNNE (CCSS)
Entity type:Individual
Prefix:
First Name:JOLYNNE
Middle Name:
Last Name:MASSENGILL
Suffix:
Gender:F
Credentials:CCSS
Other - Prefix:
Other - First Name:JOLYNNE
Other - Middle Name:
Other - Last Name:ROPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCSS
Mailing Address - Street 1:525 E MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-3423
Mailing Address - Country:US
Mailing Address - Phone:575-519-8692
Mailing Address - Fax:
Practice Address - Street 1:209 HIGHWAY 180 W
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5102
Practice Address - Country:US
Practice Address - Phone:575-956-6390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator